The Current Status of Liver Transplantation.

More than thirty patients have now undergone liver transplantation in Denver, some more than once, and survivals of up to two and a half years have been achieved. Through this and other experience it has been learned that graft viability is more critical than histocompatibility matching but that the most important factor in the ultimate outcome is prevention of rejection through vigorous immunosuppressive therapy

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Transplantation in children

Kidney transplantation in very young children, less than 2 years of age, has usually failed, mainly because of difficulties maintaining these patients on hemodialysis long enough to permit retransplantation after loss of the original graft. Liver replacement in the very young child has been associated with a higher frequency of vascular and biliary obstruction than in the older child, due to the small size of these structures. Such accidents have contributed to unsatisfactory results with biliary atresia. Transplantation of kidney or liver into older children has been more successful than transplantation of these organs into adults. Related or cadaveric kidney transplantation in the child has been followed by at least a 60 per cent patient survival for 6 to 13 years and a very acceptable quality of life. Liver replacement for diseases other than biliary atresia has been followed by a 56 per cent 1 year survival rate, and two children have survived for more than 5 years

Histopathologic alterations associated with the transplanted homologous dog liver

Homotransplanted livers in dogs developed mononuclear, lymphocytic and plasmacytic infiltration and hepatic cell degeneration roughly paralleling survival time. Extensive histologic alterations of host reticuloendothelial structures occurred. Proliferation and infiltration of mononuclear cells, principally plasmacytes, were noted in lung, kidney, perirenal supportive tissue, bone marrow, and lymph nodes. Lymph nodes, in addition, were characterized by cortical and follicular depletion. These changes were considered to represent extensive host reticuloendothelial mobilization coincident to liver homotransplant rejection. The relation between these alterations and those found in other hypersensitivity states is discussed. © 1962